| Shireen Haque, MD | |
|
1266 Highway 515 S, Jasper, GA 30143-4872 | |
| (706) 301-5434 | |
| (706) 301-5438 |
| Full Name | Shireen Haque |
|---|---|
| Gender | Female |
| Speciality | Anesthesiology |
| Experience | 18 Years |
| Location | 1266 Highway 515 S, Jasper, Georgia |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306036934 | NPI | - | NPPES |
| 5918210 | Medicaid | NC | |
| 1000744 | Medicaid | LA | |
| NC1944A | Medicaid | NC | |
| NC1473 | Medicaid | SC | |
| 1306036934 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | 0101252856 (Virginia) | Secondary |
| 207L00000X | Anesthesiology | 201100645 (North Carolina) | Secondary |
| 207L00000X | Anesthesiology | 73579 (Georgia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Wellstar North Fulton Hospital | Roswell, GA | Hospital |
| Wellstar Cobb Hospital | Austell, GA | Hospital |
| Coliseum Northside Hospital | Macon, GA | Hospital |
| Coliseum Medical Centers, Llc, Dba | Macon, GA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Piedmont Anesthesia Llc | 2163837972 | 365 |
| Mak Anesthesia Holdings, Llc | 4284917204 | 169 |
| North Atlanta Anesthesia Professionals, Llc | 5496134348 | 485 |
| Mak Anesthesia Georgia, Llc | 7315203718 | 92 |
| Entity Name | North Atlanta Professional Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316959869 PECOS PAC ID: 0840291944 Enrollment ID: O20070116000197 |
| Entity Name | Georgia Group Services, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093947236 PECOS PAC ID: 0840338018 Enrollment ID: O20091109000203 |
| Entity Name | Wellstar Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558664003 PECOS PAC ID: 6709065402 Enrollment ID: O20110127000374 |
| Entity Name | Mak Anesthesia Holdings, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912452939 PECOS PAC ID: 4284917204 Enrollment ID: O20170216001563 |
| Entity Name | Mak Anesthesia Northside Affiliates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609390103 PECOS PAC ID: 7315203718 Enrollment ID: O20171116002499 |
| Entity Name | Piedmont Anesthesia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1700474244 PECOS PAC ID: 2163837972 Enrollment ID: O20210208002823 |
| Entity Name | Fortis Health, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659960276 PECOS PAC ID: 8325446305 Enrollment ID: O20211005002270 |
| Entity Name | North Atlanta Anesthesia Professionals, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1982349296 PECOS PAC ID: 5496134348 Enrollment ID: O20220623000371 |
| Mailing Address | Practice Location Address |
|---|---|
| Shireen Haque, MD 1300 Ridenour Blvd Nw Ste 300, Kennesaw, GA 30152-4402 Ph: (707) 702-1806 | Shireen Haque, MD 1266 Highway 515 S, Jasper, GA 30143-4872 Ph: (706) 301-5434 |
Rosemarie Spillane, M.D. Anesthesiology Medicare: Medicare Enrolled Practice Location: 1266 Highway 515 S, Jasper, GA 30143 Phone: 706-692-2441 |